3:24am

Wed March 13, 2013
Health Care

'We Shouldn't Have To Live Like This'

Originally published on Thu March 14, 2013 11:05 am

If aging is not for sissies, that's especially true if you're homeless. You can be on your feet for hours, or forced to sleep in the frigid cold or seriously ill with no place to go. But, increasingly, the nation's homeless population is getting older. By some estimates, more than half of single homeless adults are 47 or older.

And there's growing alarm about what this means — both for the aging homeless and for those who have to foot the bill. The cost to society, especially for health care and social services, could mushroom.

As in many cities across the country, there are plenty of homeless people in Baltimore, Md., — about 4,000 by the latest count. In the early morning hours, dozens of bundled-up men, carrying backpacks and duffle bags, emerge from an unmarked door next to a parking garage downtown.

This is the city's overflow homeless shelter for men, and the residents need to be out by 5 a.m., before office workers start to arrive downtown for the day.

Paul Behler, 59, says he's been homeless for about a year and a half, ever since he lost his job as a concert piano tuner and restorer. Behler says some days he feels like he's 70 years old.

"Haven't got to 80 yet, thank Lord," he laughs. Still, he says he had to go to the hospital emergency room recently because he had a bout of severe tendonitis and couldn't walk without a cane.

The emergency room is a frequent destination for the homeless in every city across the U.S. The list of ailments for those living on the streets is long — blood clots, chronic pain, exposure, diabetes. It's even longer for those in their 50s and 60s, which is considered elderly when you're homeless. The life expectancy is only 64.

On a recent chilly morning, some men head from the Baltimore shelter to their jobs, as cooks or handymen. Others go to the city's day shelter to get warm.

Still others head to a nearby clinic, run by a non-profit group called Health Care for the Homeless, which opens at 7:30 a.m. About a dozen people spent the night outside the clinic sleeping on the concrete steps. It's something of a safe haven.

Here, as in similar clinics across the country, a growing percentage of patients are 50 and older. Nursing services coordinator Yvonne Jauregui says many of them are in pretty bad shape by the time they arrive.

"Their priority isn't to get preventive care. It's to make sure there's a roof over their head and food in their stomach," she says.

Jauregui notes dental care as an example. She says it's not a priority at all. "It's until, 'I can't chew because my tooth hurts so bad and the tooth needs to come out' — that's when we see them," she says.

And that makes treatment a lot more difficult. There are other challenges for the homeless. Diabetics have nowhere to refrigerate their insulin. They're not allowed to bring syringes needed for such medication into homeless shelters. Medication is often stolen. And sometimes those with serious foot and leg problems can't get to a doctor.

"They are prone to having a lot of foot issues," says Jauregui. "Plus, it's like their primary mode of transportation."

Sixty-four-year-old Linwood Hearne is a case in point. He and his wife have been homeless for four years.

"I can't balance myself. I can't walk well. I'm getting very forgetful," Hearne says. "I have prostate cancer I have a lot of mental problems that's going on with me. I'm a paranoid schizophrenic. I suffer from manic depression."

Dennis Culhane, social policy professor at the University of Pennsylvania, says individuals like Hearne are increasingly common.

"We're looking at a group of people who are sort of prematurely reaching old age," says Culhane, who's done extensive research on demographics and homelessness.

He says the growth in the aging homeless population is due largely to one group — younger baby boomers — those born between 1955 and 1965. He notes that they came of age in the late '70s and '80s, amid back-to-back recessions and a crack cocaine epidemic. Culhane says individuals in this age group are almost twice as likely as those in other age groups to be homeless.

"These are folks who have been living on the margins, in and out of jail, in and out of shelters, in and out of treatment programs for the last thirty, thirty five years," he says.

Culhane says people are just coming to grips with what that means. A few communities have started to build special housing for the elderly homeless. Baltimore and other cities are also trying to get those most likely to die on the streets into permanent supportive housing. But funds are limited.

Culhane and other experts say it's going to cost a lot more to do nothing. "It's cheaper to have them in housing, than it is to have them be homeless," he says.

But getting housing isn't easy for those with limited means. And Hearne, like lots of people living in the streets, has a history marred with mistakes.

He was evicted from public housing years ago because he stabbed a neighbor in a fight. But he says he's already served his sentence — a three-year probation — and shouldn't be condemned to life, and maybe death, on the street.

Hearne and his wife have slept outside for much of the past four years, mostly under a highway across from the Health Care for the Homeless clinic. There are blankets, bags and mattresses stacked there, along a cement wall, and a few white buckets used as urinals. About two dozen people sleep there every night.

"I know it looks terrible, but this was our home," Hearne says. "We shouldn't have to live like this."

With that, he leans over to pick something up off the ground. It's a penny.

"A penny a day keeps the doctor away, right?" he asks. "That's what they say."

What they really say is that it's good luck. And maybe it worked. Health Care for the Homeless later found Hearne and his wife a new place to live.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

Many years ago, a Simon and Garfunkel album incorporated the sounds of interviews with senior citizens. A woman on tape said bluntly: God forgive me, but an old person without money is pathetic.

RENEE MONTAGNE, HOST:

For some seniors, it's just reality, and we report next on seniors who are homeless.

INSKEEP: The homeless population in this country is aging. People stand for hours. They may sleep in the cold and when they get sick, they may have nowhere to go.

MONTAGNE: And there's growing alarm about what the means. NPR's Pam Fessler has this report.

PAM FESSLER, BYLINE: It's 4:45 a.m. in downtown Baltimore, Md., a chilly 25 degrees out, and dark.

And there's a rat. There is a rat crossing the street.

The first of several that scuttle by as bundled-up men with backpacks and duffle bags begin to emerge from an unmarked door next to a parking garage. This is the city's overflow homeless shelter. These men have to be out of here by 5, before office workers start to arrive downtown.

UNIDENTIFIED MAN #1: Real coffee today, pastries.

FESSLER: A few men grab Styrofoam cuts of black coffee as they head out. It's all they're likely to have for a while.

PAUL BEHLER: There's really not much to do until about 7 o'clock, when my storage locker opens up. I drop off my night clothes and change.

FESSLER: Paul Behler is 59. When he smiles into the cold air, you can see that his front teeth are missing. Behler's been homeless a year and a half, after he lost his job as a concert piano tuner.

BEHLER: I've lost everything I had.

FESSLER: What's left is stored in rental space for a few bucks a month. No one here likes to carry too much. Things get stolen, and the bags are heavy. Behler says some days, he feels like he's 70.

BEHLER: Haven't got to 80 yet, thank the Lord.

(LAUGHTER)

FESSLER: How do you feel today?

BEHLER: Sunday, I had to put myself in the emergency room for severe tendonitis.

FESSLER: You hear that? The emergency room. It's a frequent destination for the homeless, here and in every city in America. The list of ailments for those living on the streets is long: blood clots, chronic pain, exposure, diabetes. It's even longer for those in their 50s and 60s, which is old when you're homeless. The life expectancy is only 64.

(SOUNDBITE OF CHURCH BELLS)

FESSLER: The news is, this age group is growing fast. By some estimates, more than half of single, homeless adults are 47 or older, and the cost to society for health care, social services is about to mushroom. Some of the homeless men here are now off to their regular jobs as cooks or handymen. Others head to a nearby health clinic, which opens at 7:30.

UNIDENTIFIED MAN #2: Yes. How you do?

FESSLER: About a dozen people have spent the night here, sleeping on the concrete steps. The clinic is something of a safe haven, run by a nonprofit called Health Care for the Homeless. Everyone gets to come inside, at least for awhile.

UNIDENTIFIED WOMAN: You have an appointment with the doctor today?

UNIDENTIFIED MAN #3: No, ma'am.

UNIDENTIFIED WOMAN: You don't have an appointment today?

UNIDENTIFIED MAN #3: No, ma'am.

FESSLER: Here, as in similar clinics across the country, a growing percentage of homeless patients are age 50 and over. And nurse Yvonne Jauregui says many of them are in pretty bad shape by the time they arrive.

YVONNE JAUREGUI: Their priority isn't to get preventive care. It's to - you know, make sure there's a, you know, roof over their head and food in their stomach. And getting the teeth cleaning is not a priority at all. It's until I can't chew because my tooth hurts so bad, and the tooth needs to come out - that's when we see them.

FESSLER: Which makes treatment a lot more difficult. And there are other challenges for the homeless. Diabetics have nowhere to refrigerate their insulin. They're not allowed to bring syringes needed for medication into shelters. Medication is often stolen. Those with serious foot and leg problems sometimes can't even get to the doctor.

JAUREGUI: They are prone to having a lot of foot issues. Plus, it's like their primary mode of transportation.

LINWOOD HEARNE: I can't balance myself. I can't walk well. I'm getting very forgetful.

FESSLER: Sixty-four-year-old Linwood Hearne and his wife have been homeless for four years, sleeping most of that time under the highway across from the clinic. He's fairly typical.

HEARNE: I have prostate cancer. I have a lot of mental problems that's going on with me. I'm a paranoid schizophrenic. I suffer from manic depression.

DENNIS CULHANE: We're looking at a group of people who are sort of prematurely reaching old age.

FESSLER: Dennis Culhane, of the University of Pennsylvania, says the growth in the aging homeless population is due largely to one group - younger baby boomers, those who came of age in the '70s and '80s amid back-to-back recessions and a crack cocaine epidemic. He says they're almost twice as likely as others to be homeless.

CULHANE: These are folks who have been living on the margins, in and out of jail, in and out of shelters, in and out of treatment programs for the last 30, 35 years.

FESSLER: And now, they're getting old. Culhane says people are just coming to grips with what that means. A few communities have started to build special housing for the elderly homeless. Baltimore and other cities are trying to get those most likely to die on the streets into permanent, supportive housing, But funds are limited. Culhane and other experts say it's going to cost a lot more to do nothing.

CULHANE: It's cheaper to have them in housing than it is to have them be homeless.

TONY SIMMONS: This one, Charles and 20th, have you all tried that one yet? The high rise?

FESSLER: But getting housing isn't easy when you have limited means. Tony Simmons, 51 and also homeless, is trying to help Linwood Hearne and his wife find a place to live. Simmons suggests that Hearne check out a nearby subsidized senior complex.

SIMMONS: You can actually go into the building and put in an application. And here's the trick: always look at the mailbox. If you see eviction notices, then these apartments are available. It's a bad way to look for it, but that's how I find them.

FESSLER: Like lots of people living in the streets, Hearne has a history marred with mistakes. He was evicted from public housing years ago because he stabbed a neighbor in a fight. That's hard to believe today. He seems so frail. Hearne says he's already served his sentence and shouldn't be condemned to life - or maybe even death - on the street.

(SOUNDBITE OF STREET NOISES)

FESSLER: Hearne and his wife take me outside.

HEARNE: Take your time, baby.

FESSLER: They want to show me where they slept for much of the past four years. Hearne hobbles with his cane across a four-lane road, breathless as he tries to avoid getting hit by a car.

You OK?

HEARNE: I'll make it.

FESSLER: In front of us, under the highway, there are blankets, bags and mattresses stacked along a cement wall, and a few white buckets used as urinals. About two dozen people sleep here every night.

HEARNE: I know it looks terrible, but this was our home. We shouldn't have to live like this.

FESSLER: And with that, he stops and leans over to pick something up off the ground. It's a penny.

HEARNE: A penny a day keeps the doctor away, right?

(LAUGHTER)

FESSLER: Is that true?

HEARNE: That's what they say.

FESSLER: Well, what they really say is, it's good luck. And maybe it worked. Three weeks later, Health Care for the Homeless found Hearne and his wife a new place to live. That leaves the city with about 4,000 other homeless residents.

Pam Fessler, NPR News.

MONTAGNE: Hear about one couple trying to deal with aging while living outside in a tent, later today on ALL THINGS CONSIDERED.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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